Memorandum of Agreement

Physician health and safety: PMA Memorandum of Agreement

Ensuring the physical and psychological safety of doctors in their workplaces is imperative in order to provide the best care possible to patients. To this end, Doctors of BC has taken significant action to improve workplace safety through the Memorandum of Agreement on Physical/Psychological Safety (now referred to as the Physician Health and Safety Agreement). Incorporated into the 2019 Physician Master Agreement, this Agreement makes it so that physicians have the opportunity to be included in widespread systemic change to better support physical and psychological health and safety in the workplace. It is also the first agreement of its kind in Canada and the first time Doctors of BC has worked with the Ministry of Health, the Health Employers Association of BC, health authorities, and health care related bargaining associations on issues specific to physician safety. 

What members told us

Doctors of BC is acutely aware of physical and psychological safety concerns in the physician workplace. In our 2021 Health Authority Engagement Survey - What We Heard Report, half of respondents indicated they believe effective actions are not being taken to promote a healthy and safe workplace. And in our 2021 Health Authority Engagement Survey, two key issues stood out:  

Improving physician health and safety in the workplace

What are the goals of the Physician Health and Safety Agreement?

The ultimate goals of the Agreement are to:

• strengthen relationships between Doctors of BC, Medical Affairs departments, and Occupational Health and Safety departments within health authorities to better support physicians in their workplaces
• provide structures and mechanisms to represent physicians in these matters, including the opportunity to influence policy and decision making at both the provincial and regional level
• enhance processes and communications around all aspects of physician health and safety, more specifically by ensuring transparency and feedback loops when raising issues without fear of reprisal

 

How does the Physician Health and Safety Agreement address safety in the workplace?

The Agreement has established a number of new regional and provincial committees, structures, and working groups focused specifically on enhancing and improving physical and psychological health and safety in the workplace. It aims to accomplish this by supporting activities that enable consistent policies and procedures for physician specific occupational health and safety issues including: exposure management, contact tracing, enabling feedback loops, and more. The Agreement also provides funding for the following committees, structures, and Working Groups to begin activities that support physician health and safety. 

Structures:

• SWITCH BC – an independent, provincial non-profit whose role is to lead and support provincial, systemic improvements in the health, safety, and well-being of all healthcare workers. The governance model is unique in BC and Canada, with a Board of Directors comprised of representatives from all health sector bargaining associations, Doctors of BC, the Health Employers Association of British Columbia (HEABC), and the Ministry of Health.

Committees and Working Groups: 

• Physician Specific Issues Working Group: a joint provincial committee/working group between the Ministry of Health, health authorities, Health Employers Association of BC (HEABC), and Doctors of BC, whose purpose is to help inform the BC Health Care Occupational Health and Safety Society, as well as identify and discuss regional-level issues to ensure consistency across the province. 
• Physician Health & Safety Advisory Group: an internal group comprised of Doctors of BC physician representatives and Doctors of BC staff who aims to provide updates to and plan/prioritize ideas for the Physician Specific Issues Working Group and each Regional Working Group.
• Regional Physician Health and Safety Working Groups: established within each Health Authority and comprised of Doctors of BC physician representatives, Regional Advisors and Advocates, and staff from Health Authority Medical Affairs and the Occupational Health and Safety department, the purpose of these groups is to build relationships, identify and discuss new opportunities for physician input, and develop activities, projects, and initiatives related to physician health and safety that can be funded under the Agreement.

Current work under the Physician Health and Safety Agreement

A number of regional and provincial projects and activities are underway that seek solutions to creating systemic change and that create opportunities for physicians to raise and provide input into health and safety issues and processes. Here is a list by Health Authority:

Fraser

 

• Blood or Body Fluid (BBF) Exposure Follow-up and Support Project: This pilot project aimed to ensure that Fraser Health Medical Staff (including credentialed physicians) receive blood or body fluid exposure follow-up and support services, provided through the Provincial Workplace Health Contact Centre (PWHCC). Credentialed physicians in Fraser Health who experience an occupational blood or body fluid exposure report to the nearest Emergency Department for blood work, and the PWHCC’s occupational health nursing team then contacts the physician to discuss results, assess exposure risk, and provide relevant follow-up recommendations.
  • Between October 20, 2021 and October 20, 2022, a total of 50 Medical Staff had engaged in the BBF exposure support and follow-up process. During the pilot project phase (October 2021 to March 2022), staff reported 21 exposures.
  • Following closure of the successful pilot project, Fraser Health signed a Service Agreement to continue this service for Medical Staff in the Fraser Health region. Read the final report.
• Leadership Coaching Pilot Project: This project aimed to help leaders deepen their awareness and effectiveness, identify challenges and opportunities more clearly, build resilience, and expand their “systems” perspectives – all of which is critical for delivering high-quality patient care. A total of 17 participants, including physician leaders and department heads from 5 sites, were a part of this pilot project. Read the final report.
• Patient Voices & Psychological Safety: The inclusion of patient partners in improving healthcare is critical to all future health system improvement strategies. Through this project, it was felt the voice of end-users of the health system may be helpful in setting up some conditions for a shift in healthcare culture and was done so via an online focus group discussion. Read the final report.
• Project Lead and Analyst Support Roles: It was identified that continuing support is needed to help advance the work and project infrastructures in the region to ensure success and timely completion of both ongoing and future projects. Read the final report.

Interior

A number of projects have been making progress in 2022, including:

• Medical staff training and education pilots on violence prevention and physical safety
• Medical staff incident reporting and investigation review project
• Collaboration with IHA protection services to conduct site safety meetings and reviews with medical staff
• Medical staff peer support program review and pilots
• Review of medical staff immunization and vaccination processes

Island

1. Physician Discipline and Respectful Workplace Processes: This project sought feedback from physicians on existing policies, processes and communications related to respectful workplace and disciplinary processes.

The process for obtaining medical staff feedback involved physician focus groups comprised of diverse physician representatives (family and specialist physicians) from across the Island. These focus groups took place over the course of 2020 and 2021.

As a result of this project, physicians drafted recommendations to the Island MOA Working Group. One recommendation was to form a specific Respectful Workplace Working Group, composed of health authority, Doctors of BC, and physician representatives to further explore and address the identified themes. This committee was developed through a regional nominations process for physician representation, and began its work in March 2022.

Status: Phase II of this project is underway and expected to continue through end of 2023.

2. Violence Reporting Processes: This project involves examining current processes and identifying barriers to physician violence reporting. It is expected that a set of recommendations will be developed around process improvement, and that this data will also serve as a channel for provincial reporting.

Status: Project is in the development phase.

3. Psychological Safety Webinars: The Island MOA Working Group funded a series of virtual psychological safety webinars, hosted to support educational opportunities, promote psychological safety in health care teams, and enhance quality improvement and leadership skills of physicians. Dr Mamta Gautam was the topic speaker for these sessions, which welcomed physicians from across the Island virtually. Click here for topic details.

Status: Project complete. New and expanded opportunities for medical staff are currently being explored for 2023.

Participants were extremely grateful for the opportunity to participate in these sessions.

“Thank you! Such an important topic and conversation, especially at this point in time in healthcare in Canada.”

“Dr. Gautam is a very thoughtful educator. I wish that the next time I'm on the receiving end of constructive feedback, it is delivered by someone who has learned from her style! This talk was exactly what I needed. Thank you for the rich discussions.”

4. Psychological Safety in the Workplace

This pilot project implemented a department-wide survey in the Island Health region to assess physician psychological safety in the workplace, and identify areas for improvement. The survey was developed through the Island MOA Working Group with physician contribution, and vetting and distribution by TWI Surveys Inc. Along with presentations to health authority leadership and the medical staff, a summary report was also provided to the Island MOA Working Group who will use the results to determine recommendations for next steps.

Status: Recommendations and next steps to be determined.

North

Process Mapping for Incident Reporting: An incident can be physical violence, a physical safety concern such as exposure or injury, or psychological safety, including discipline and respectful workplace issues. This project aimed to identify areas of improvement to create a more simplified pathway for physicians, medical leadership, and health authorities to report incidents, ultimately creating a more psychologically safe workplace.
Feedback was acquired through forty-three interviews among family physicians, specialists, MSA Presidents, Chiefs of Staff/Deputy Chiefs of Staff, and Northern Health Regional Medical Directors and Leadership.
The feedback led to the development of a number of themes and recommendations, including the formation of a working group to:

• Review the NH Respectful Workplace Policy to ensure inclusion of physicians' needs and wants
• Create and annually deliver a CME-accredited course on the Northern Health Respectful Workplace Policy (NHRWP) to physicians, Chiefs of Staff and Deputy Chiefs of Staff
• Create a physician peer support and resource network
• Ensure a dedicated space on the Northern Health website for NHRWP specific to physicians

Vancouver & Coast

Physician Occupational Safety and Health Program (POSH): This program provides occupational health services for physicians, specifically on communicable disease management. It was created in response to COVID-19, to both provide these services in a crisis, and to help keep physicians safe and healthy.

• Since April 2020, POSH has assisted more than 3,000 physicians, including 960 contact tracing cases and has provided responses to over 200 vaccine related inquiries. 

The program is currently expanding to provide a concierge service for all medical professionals within VCH to report workplace violence. The main components of this project include:

• Retroactively analyzing Code WHITE and PSLS data for insights into the type of violent incidents, and to obtain a baseline of what is under-reported 
• Developing a reporting pathway for Health and Safety incidents
• Expanding disability management support in supporting a return to work after a Leave of Absence (LOA) or violent incident

Click here to read more about the overall program.

Provincial Health Services Authority

Psychological Health & Safety Physician Education and Training: this project seeks to leverage content that was previously developed at BC Women’s and Children’s and expand training to physicians across PHSA. Training concepts would aim to operationalize clinical research and teaching practice to support a psychologically healthy and safe workplace. The following modules are currently under development:

• Foundation Module - Setting the stage: Psychological Health & Safety in the Workplace
• Module 1 - TIPS on TIP: Trauma Informed Principles and Practice
• Module 2 - Healthy Conflict & Just Culture: Learning and Innovation
• Module 3 - Motivational Interviewing for Health Care Providers
• Module 4 - The Art of Active Listening – Peer Support & Patient Engagement
• Module 5 - From Bystander to Upstander: Responding to Disruptive Interactions in the Workplace
• Module 6 - Healthy Options: Giving and Receiving Feedback and Difficult Conversations

Providence Health Care

Violent Incident Reporting: PHC is evaluating a mechanism for violent incident reporting, and looking to collaborate with both the Section of Emergency Medicine and the MSA Wellness working group in this process.

Evaluating psychological safety in the workplace: Physicians were compensated to attend debrief sessions that contributed to an environmental scan of the current state of the 13 pillars of psychological safety at PHC. Recommendations from the debrief sessions have been shared with senior leadership and the physicians that participated.

Provincial Updates

WorkSafeBC Physician Registration Guide: Doctors of BC and WorkSafeBC have updated the WSBC Physician Registration Guide to provide physicians with enhanced information on the processes and protocols for registering for WSBC coverage. The revised guide can be viewed here.

For further information specific to your region, please contact your Regional Advisor and Advocate.

Doctors of BC policy on workplace safety

Supporting BC physicians in their pursuit of workplace health and safety has become an increasingly important priority for Doctors of BC. Our work in this area includes our 2017 policy statement Promoting Psychological Safety for Physicians, our 2016 policy statement Preventing Violence in Healthcare, and local initiatives established via the Divisions of Family Practice and Medical Staff Associations.

For Doctors of BC resources on physician health and safety, please visit our Physician Health & Safety webpage.

The impact of physical and psychological safety

Physical and psychological health and safety are vital in creating safe work environments that contribute to injury prevention and that cultivate innovative, engaged, and effective teams. Physician health and safety is comprised of two components:

• physical safety, such as protecting physicians from accidents or acts of violence in the workplace, and
• psychological safety, such as bullying, harassment, discrimination, racism, and intimidation.

In the absence of psychological safety, physicians are less likely to speak up, raise patient safety issues, suggest new ideas, or ask for help when they experience any of these events, for fear of reprisal or embarrassment. Research also shows that creating a work environment in which doctors feel safe contributes to their overall well-being, and is crucial for organizational efforts aimed at reducing medical errors, improving the coordination and quality of care, and increasing cost effectiveness. 

Who do I contact if I am experiencing a safety issue?

Any physician who is experiencing issues of physical or psychological health and safety, or who has been involved or impacted by it in the past, is encouraged to contact your local Regional Advisor and Advocate.